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Radiology and radiological procedures in everyday dentistry

Dr Marcel Noujeim, Professor and Graduate Programme Director of Oral and Maxillofacial Radiology at the University of Texas Health Science Center at San Antonio, describes why it's important for dental professionals to perform and interpret radiographic procedures.

What is the role of oral and maxillofacial radiology in everyday dental practice?

Dental diagnostic sciences, especially oral and maxillofacial radiology, are considered to be the cornerstone (or starting point) for every emergency or comprehensive dental treatment. This is an important field of dentistry due to x-ray images being able to show non-clinically visible dental and osseous anatomical structures, since oral clinical manifestations must have a hidden root in the bone and are covered by soft tissues.

Every successful treatment plan must have a complete and exhaustive diagnosis showing all covered or uncovered aspects of the maxillofacial complex. Osseous manifestations of multiple conditions – starting from simple periapical abscess to the most complicated osseous disease or manifestation of a systemic condition – are detected radiographically using multiple oral and maxillofacial radiology techniques.

Why is it important for dental professionals to perform and interpret radiographic procedures, such as Cone Beam Computed Tomography (CBCT)?

With the advancement of technology and computers, sectional images have become easily accessible through tomography and medical computed tomography. The development of CBCT was the latest advent in the world of dentistry. It opened multiple opportunities by offering new perspectives, new possibilities, and a multitude of views for every single structure.

These advances come with more complicated viewing software programmes to be able to manage the huge amount of data offered by this technology, which require experts in acquiring, processing, reading and manipulating these images. The high-resolution images and the detailed presentation of anatomical structures, as well and the obvious and subtle osseous changes in the presence of pathology, constitute a challenge for dental professionals as they are responsible for every single finding contained in these images.

Can you describe the type of techniques and training that are required for certification in oral and maxillofacial radiology?

According to the American Dental Association and the American Board of Oral and Maxillofacial Radiology, a certified oral and maxillofacial radiologist must have extensive knowledge in radiation physics, biology, and protection; imaging technology and computer-based image evaluation; and interpretation of conventional radiographic images as well as advanced modalities including CT, plain tomography, MRI, subtraction radiography, and cone beam computed tomography.

The person must also develop a strong background in head and neck anatomy, clinical and microscopic pathology, oral medicine, and research methods.

Your lecture will address interdisciplinary collaboration in dental imaging and radiology. What are the key areas that you would like to highlight?

Oral and maxillofacial radiology is gaining importance exponentially with time as an essential element in diagnosis and treatment planning in all dental specialties. The radiology reporting service at my dental school is one of the biggest and the busiest in the world of maxillofacial imaging where our role in dental treatment is totally fulfilled.

However, during our daily practice we get to deal with cases where we have to – either by teaming-up with the patient’s dentists or physicians – move the dental treatment to the backseat and explore the presence of serious and sometimes life-threatening diseases. This major role cannot be played without a thorough knowledge of CT anatomy of the entire acquired image volume, anatomic variations, and observation of abnormalities as well as a rigid approach that all image data be systematically reviewed for disease.

During my lecture, we will go through a series of cases where CBCT volumes were referred to our service for regular consults and we detected findings that revealed extremely more serious conditions.

As an upcoming speaker at the FDI World Dental Congress, what makes this international event different from other dental congresses?

I have attended and lectured at many general and specialized dental scientific meetings, and I am very excited to speak at the FDI World Dental Congress in Buenos Aires. I have heard a lot about this event and I know that it is one of the oldest and the most prestigious international scientific congresses.

As oral and maxillofacial radiology continues to increase in importance among dental specialties, more exposure to our field is needed and bringing it at the FDI level will be the ultimate platform. I will greatly benefit from this congress on a personal and professional level, as I will get the chance to meet with the most eminent names and leaders in the oral health profession from around the globe.